Selective Laser Trabeculoplasty and i-Stent

Selective Laser Trabeculoplasty and i-Stent

Dr. Michael G. Richie, M.D.

i-Stents, Selective Laser Trabeculoplasty

Tired of Using and Paying for Glaucoma Drops?

Maybe an i-Stent is in the Cards for You
By Dr. Michael Richie, MD, Richie Eye Clinic, Faribault, MN


Nothing, not even sub-zero weather gets in the way of Bertha’s monthly bridge game. She has the hors d'oeurves ready, wine is open and breathing, and the gang is all here: Joe, Clara and Frank. Bertha, as the host, shuffles the cards and away they go.

Conversation and cards go hand in hand and, as with many septuagenarians, the talk often drifts to medical issues: who has what ailment, which doctor is the best, and whose medicines cost the most. This week Bertha takes the lead when telling just how much her glaucoma eye drops cost…over $100 for a little bottle that only lasts a month.

That is when Joe chimes in, "Haven’t you tried any of the new glaucoma treatments that can help reduce the amount of drops you need?"

"What?" stammers the stunned Bertha?

"That’s right," said Clara. "Joe had a laser treatment and his pressure has been great. He doesn’t need drops at all."

"In fairness," said Joe, "I never actually started the drops. My doctor suggested the laser right away instead of trying drops. He said it works about as well as the drops to lower my pressure, but without the hassle of medicating every day."

Clara then explains to Frank that glaucoma is a disease of the eye in which high pressure can damage the nerve in the back of the eye, resulting in a gradual loss of peripheral vision. Treatment is to lower the pressure, often with drops but now more and more with a laser called SLT. "Selective Laser Something Or Other Starting with a T," she concludes.

Joe adds, "It works in about three out of four people, and the pressure will stay down for five years in three out of four. That is every bit as good as drops can do. The best part is that if it is still working five years after the treatment, it will almost certainly be working in 10 years."

"What if it doesn’t lower your pressure?" Frank asks.

"You can always try drops then," Clara offers.

"You know," Bertha says as her eyes light up, "my doctor talked about something he could do if I have cataract surgery. Do either of you understand that?"

"Well," said Joe, "that sounds like this new thing with that trendy name. Clara, what did he call that thing? An iPod, iPick…something like that."

"That would be the i-stent, you techno-wizard" said Clara as she rolls her eyes at her husband of 52 years. "The i-stent is this great little valve your doctor can put in to lower pressure. I have read all about it. It is really tiny, microscopic even, and is placed inside the eye during cataract surgery. As I understand, it helps to lower pressure by acting like a small drainage channel to let fluid out of the eye. It is covered by insurance but only if placed during cataract surgery. Like the SLT laser, it lowers pressure like any one eye drop would."

"So how does that help in my case" said Bertha?

"Well," Clara continued, "if you take one glaucoma drop to control your pressure, and then have cataract surgery with the i-stent placed during the surgery, it is likely that you will not need your glaucoma medicine to keep the pressure down after surgery. If you take three different glaucoma medicines to control your pressure, you will probably only need two after having the i-stent put in."

"Can't I just have two or three i-stents placed to get rid of all my medicines?" asked Bertha.

"In fact, you can," replied Joe. "The problem is that insurance will only pay for one. As I understand it, though, you choose to have more than one put in if you want to pay for it. It is less than my grandkid’s braces."

"So let me summarize," Frank says as he leans back in his chair. "For glaucoma I can put in drops to lower the pressure, or maybe a laser called the SLT. Both options work well, but I have to buy drops every month while the laser is a one and done treatment. Additionally, if I am having cataract surgery I can choose this istent valve to lower pressure, which and may get me off of glaucoma drops after surgery? Seems like simple choices to me. Now let’s play cards."

"Okay," Bertha says, "but forget Bridge…let's play poker!"

"Again?" Frank whines. Then, after a heavy sigh, "Alright, I’m in…but can we use the chips this time, Bertha? I am still looking for my socks from the last time we played poker your way."

Download a PDF of iStent and SLT

About the video: Dr. Michael Richie discusses selective laser trabeculoplasty, SLT glaucoma treatment. Although SLT is not a new treatment, this glaucoma treatment's placement in therapy is changing. Data collected on the SLT treatment shows that 75 percent of people receiving selective laser trabeculoplasty have successful lowering of pressure in the eye. Since the SLT treatment works well, and statistics show longer-term success (about five years), it is growing in popularity. In this video, Dr. Michael Richie covers the benefits of SLT treatment for glaucoma and demonstrates an entire SLT treatment procedure, discussing the effects to the trabecular meshwork of the eye.

View more videos from Dr. Richie here on our YouTube channel.

For more information on glaucoma surgery and i-stents, contact the Richie Eye Care team at 507-332-9900 today.

For more information, contact Richie Eye Clinic, Faribault MN.

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